JCM OSCE AED UCH 5/9/2012 Case 1 • 11/M • Fought with classmate • Right arm pain with tenderness • What is the X-ray finding? • Name three differential diagnoses from the Xray finding. • What will be your management? Case 2 • 13 months/M • Cough for 3 days • Noisy breathing for a day • Name 2 CXR findings. Are they pathological? • Name 3 neck X-ray findings. • What is the diagnosis? • Name 2 medications for the disease. Case 3 • 90/M • Known COAD • Chest pain for a day • Besides the emphysematous and fibrotic changes of the lung, what are the X-ray findings? • What are the two differential diagnoses? • What further imaging is helpful? • If the patient deteriorates with SOB, what will be your management? Case 4 • A 59 years old lady was recently prescribed transdermal patch for treatment of her Alzheimer’s disease because of poor oral drug compliance. • The patient was found to have vomiting, diarrhoea, dizziness and generalized limb weakness the day after starting the patch. • The patient was fully conscious, with blood pressure 137/73 mmHg and pulse rate of 58 bpm. • Her pupil size were 2 mm, chest clear on auscultation and bowel sounds were normal. • What is the most likely ingredient in the patches? • Which drug class does the drug belong to? • Which enzyme is inhibited by the drug? • What is the most important step in the management of this patient? • Name the antidote(s) for overdose of this drug. Case 5 • 47/F • Hx of Antithrombin III deficiency • Presented with • Headache for a few days • Right side weakness for a day • BP 130/80, p 90/min • Afebrile • GCS 13/15; E3V4M6 • PERL • Right hemi-paresis with power grade 4/5 • What is the CT finding? • What is the diagnosis? • Any laboratory test can help to make the diagnosis? • Any further imaging can help to confirm the diagnosis? • What is the mainstay of treatment?